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General NPI Number Information
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NPI Number | 1568464378
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Entity Type | Individual
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Provider Name | CHRISTOPHER J MANCUSO MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 301 S 7TH AVE SUITE 3220
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City | WEST READING
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State | PA
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Zip | 19611-1410
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Country | US
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Telephone | 610-376-8671
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Fax | 610-376-6387
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Provider Business Mailing Address
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Address Line | 301 S 7TH AVE SUITE 3220
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City | WEST READING
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State | PA
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Zip | 19611-1410
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Country | US
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Telephone | 610-376-8671
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Fax | 610-376-6387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | MD059819L
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License Number State | PA
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